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2010 STANDARDIZED MEDICARE SUPPLEMENT PLANS

A	B	C	D	F F*	G	K	L	M	N
Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, 100% Part B coinsurance, First three pints of blood each year Hospice Part A coinsurance	Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, 100%Part B coinsurance, First three pints of blood each year Hospice Part A coinsurance	Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, 100% Part B coinsurance, First three pints of blood each year Hospice Part A coinsurance	Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, 100% Part B coinsurance, First three pints of blood each year Hospice Part A coinsurance	Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, 100% Part B coinsurance,* First three pints of blood each year Hospice Part A coinsurance	Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, 100% Part B coinsurance, First three pints of blood each year Hospice Part A coinsurance	Hospitalization and preventive care paid at 100%; other basic benefits paid at 50%	Hospitalization and preventive care paid at 100%; other basic benefits paid at 75%	Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, Part B coinsurance, First three pints of blood each year, Hospice Part A coinsurance	Hospital Part A coinsurance plus coverage for 365 add’l days after Medicare benefits end, Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER, First three pints of blood each year, Hospice Part A coinsurance
		Skilled Nursing Facility Coinsurance	Skilled Nursing Facility Coinsurance	Skilled Nursing Facility Coinsurance	Skilled Nursing Facility Coinsurance	50% Skilled Nursing Facility Coinsurance	75% Skilled Nursing Facility Coinsurance	Skilled Nursing Facility Coinsurance	Skilled Nursing Facility Coinsurance
	Part A Deduct.	Part A Deduct	Part A Deduct.	Part A Deduct.	Part A Deduct.	50% Part A Deduct.	75% Part A Deduct.	50% Part A Deduct.	Part A Deduct.
		Part B Deduct.		Part B Deduct.
				Part B Excess (100%)	Part B Excess (100%)
		Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Foreign Travel Emergency	Out of pocket limit $[ ]; paid at 100% after limit reached	Out of pocket limit $[ ]; paid at 100% after limit reached	Foreign Travel Emergency	Foreign Travel Emergency

***Deductible amounts and out-of-pocket limits announced annually by CMS.

*Plan F also has an option called a high deductible Plan F. This high deductible plan pays the same benefits as Plan F after having paid a calendar year ($***) deductible. Benefits from high deductible Plan F will not begin until out-of-pocket expenses exceed ($***). Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductible for Part A and Part B, but do not include the plan’s separate foreign travel emergency deductible.